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The results of this systematic review indicate that dry needling may be an effective intervention for appropriate patients with musculoskeletal pain. At the same time, the very low to moderate quality of the evidence limits the strength of conclusions that can be drawn, and optimal treatment techniques and dosing are not known. Dry needling appears to be more effective than sham, control, or other assessed treatments for improving pressure pain threshold, and more effective than sham or control for reducing pain, in the short term. However, dry needling is neither more successful than other assessed treatments beyond 12 weeks nor more helpful for improving functional outcomes.